BCCT plans to write a summary on black cohosh (Actaea racemosa). While our summary is in development, you can visit these sites for more information:
- Ottawa Integrative Cancer Centre:
- About Herbs: Black Cohosh
- CAM-Cancer: Black cohosh (Actaea racemosa)
- National Institutes of Health (NIH) Office of Dietary Supplements: Black Cohosh
Clinical Practice Guidelines
According to the Society for Integrative Oncology’s 2009 clinical practice guidelines, there is not enough evidence to recommend black cohosh for relieving hot flashes.1
Managing Side Effects and Promoting Wellness
Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being
Black cohosh is promoted as a treatment for hot flashes. However, evidence to date does not support this use.
The About Herbs summary for black cohosh lists several cautions, adverse reactions and herb-drug interactions, including interactions with chemotherapy. Refer to About Herbs: Black Cohosh. BCCT advises that before using this product, consult with a clinician knowledgeable in using natural products in cancer treatment.
According to CAM-Cancer, “Black cohosh appears to be relatively safe; but pre-existing liver damage is a contraindication.”2
According to the NIH office of dietary supplements, “Across the world, reports have described at least 83 cases of liver damage—including hepatitis, liver failure, elevated liver enzymes, and assorted other liver injuries—associated with black cohosh use. However, there is no evidence of a causal relationship. It is possible that at least some reported cases of hepatotoxicity were due to impurities, adulterants, or incorrect Acteae species in the black cohosh products used. However, no one independently analyzed these products to confirm the existence of these problems.”3 Another consideration is that black cohosh is often mixed with other herbs in formulas (such as for menopausal symptoms), and some of these other herbs such as skullcap, valerian and/or chaparral have been associated with liver problems.4
The key takeaway is to read the label to be knowledgeable about all the ingredients in a product, and use quality supplements to make sure you're getting what's actually on the label. See the BCCT summary on Quality and Sources of Herbs, Supplements and Other Natural Products.
BCCT does not recommend therapies or doses, but only provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated.
Dosage recommendations are available from these sources:
- Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010.
- Natural Medicines Database (requires purchase)
Integrative Programs, Protocols and Medical Systems
|For more information about programs and protocols, see our Integrative Programs and Protocols page.|
- Programs and protocols
- Ottawa Integrative Cancer Centre:
- BCCT, KNOW Oncology and Ottawa Integrative Cancer Centre: Patient Education Brochures
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Memorial Sloan Kettering Cancer Center: About Herbs, Botanicals and Other Products
- Cancer Research UK
- CAM-Cancer Collaboration: CAM-Cancer
- American Botanical Council: HerbMed
- Lone Star Medical Group: Natural Alternative Treatments
- Therapeutic Research Center: Natural Medicines Database
- National Cancer Institute: Office of Cancer Complementary and Alternative Medicine